Provider Demographics
NPI:1124183843
Name:FERNANDO-LANGIT, ANNALISA C (OD)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:C
Last Name:FERNANDO-LANGIT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9073 COBBLESTONE LANE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:619-316-1978
Mailing Address - Fax:
Practice Address - Street 1:11420 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-860-1339
Practice Address - Fax:562-860-1339
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13013T152W00000X
CA13013TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADY976ZMedicare UPIN